op  PUBLIC  IJTEHEST 


THE 


BY 


EVENTS,    JVI.D 


Superintendent  of  the  Cincinnati   Sanitarium  (A  Private   Hospital 

for  the  Insane),  Late  Superintendent  of  the  Indiana  State 

Hospital  for  the  Insane,  Member  of  the  American 

Medico-Psychological  Society,  etc.,  etc. 


« JR«a.;  befort  the  Hftotiasippi  Valley  Medical  Association,  Oct.  4,  1899, 


PROBLEMS  OF  PUBLIC  INTEREST  CONCERNING 
THE  INSANE. 


ORPHEUS   EVERTS,  M.D.,   College  Hill  Station,   Cincinnati,  Ohio. 


There  are  several  problems  of  public  interest  involved  in  the 
present  relations  of  society  to  the  insane.  Among  the  more  important 
of  these  are  questions  of  dependency,  the  curability  of  the  insane,  arid 
the  preventability  of  insanity. 

Each  of  these  questions  presents  two  aspects  for  consideration — 
one  appealing  to  whatever  altruistic  sentiment  may  have  been  devel- 
oped with  our  growth,  and  the  other  to  that  selfish  sentiment  tbat  is 
common  to  the  race. 

That  there  is  a  large  number  of  insane  persons,  increasing  rather 
than  diminishing,  in  every  civilized  state,  is  a  fact  familiar  to  all  intel- 
ligent interested  observers. 

That  the  insane  constitute  a  dependent  class  of  society  is  equally 
apparent. 

Independence  implies  mental  capabilities  corresponding  to  im- 
^  pending  necessities  under  any  given  circumstances.  But  few  living 
'V  beings  are  superfluously  endowed  for  the  end  indicated.  A  large 
^  proportion  of  animal,  as  well  as  vegetable,  specializations  entering 
life  upon  terms  of  apparent  equality,  die  prematurely  because  of  in- 
herent lack  of  capability  to  meet  or  resist  the  exigencies  of  environ- 
ments. 

The  complex  environments  of  civilized  life  require  much  greater 
capability  on  the  part  of  individuals  to  maintain  independence  than 
are  required  by  the  more  simple  conditions  of  savagery. 

Insanity  implies  mental  impairment,  hence  lessened  capability, 
noticeable  as  contrasting  previous  conditions  manifested  by  the  per- 
sons supposed  to  be  insane. 

Liability  to  become  insane  under  ordinary  provocation,  is  asso- 
ciated, as  a  general  rule,  with  inherent  defects  of  organization  charac- 
teristic of  a  class  of  persons  whose  natural  capabilities  are  below  a 


2151 5 1 


common  level  at,  or  even  above,  which  independence  implies  con- 
stant, anxious  and  often  unsuccessful  effort.  A  slight  degree  of  im- 
pairment, therefore,  may  be  sufficient  to  reduce  a  self-supporting 
person  to  a  condition  of  dependency. 

That  exceptional  persons  of  more  than  ordinary  capability  have 
become  insane  under  exceptional  circumstances — or  that  rare  instances 
of  exaggerated  capability  associated  with  some  degree  of  mental  dis- 
order, have  been  observed — when  properly  considered  should  not  dis- 
credit the  foregoing  statement  or  inferences. 

It  is  true — if  mental  phenomena  are  sequential  to  cerebral  activ- 
ities, orderly  and  disorderly,  and  reflect  cerebral  conditions,  sound 
and  unsound — that  it  must  be  possible  for  whoever  or  whatever  is 
endowed  with  brains  to  become  insane  under  sufficient  provocation. 
Fortunately  for  most  of  us,  however,  ordinary  provocation  is  not 
sufficient  to  seriously  derange  the  mental  mechanisms  of  a  large 
majority  of  mankind. 

Neither  should  the  fact  that  a  considerable  number  of  active,  and 
apparently  capable,  business  men  suffer  and  are  destroyed  by  what  is 
now  familiarly  known  as  "  paresis,"  affect  the  position  taken  unfavor- 
ably." Clinically  considered,  in  the  sidelights  of  commemorative  cir- 
cumstances, these  men  are  found  to  be  not  exceptional  persons — but 
belonging  to  a  class  not  only  liable  to  become  insane  because  of  in- 
herited peculiarities,  but  constitutionally  prone  to  indulgence  in  prac- 
tices more  than  ordinarily  provocative  of  cerebral  disease. 

Degenerative  impairment — hence  incapability  of  self-support — on 
the  part  of  the  insane  being  admitted,  the  question  of  public  interest 
is :  What  shall  be  done  with  and  for  them  ?  All  savage  peoples  aid 
and  abet  Nature  in  her  methods  of  disposing  of  the  defective  and 
incompetent,  in  all  of  her  kingdoms,  by  neglects  and  practices  quite 
as  cruel  as  her  own.  Our  own  ancestors  were  not  exceptional  in  this 
respect. 

Among  civilized  peoples  it  has  come  to  be  recognized  as  expedient 
and  dutiful  for  the  strong  of  our  kind  to  succor  and  sustain  the  weak, 
no  matter  what  the  burden  may  be.  Why  this  is  or  how  it  came  to  pass, 
need  not  be  discussed  in  this  connection.  Enough  to  say  that  it  is  an 
"  inevitable  sequence  of  antecedent  conditions;  "  that  the  duty  is  clear 
and  will  nevermore  be  shirked  while  our  people  advance  along  the 
lines  of  Christian  civilization.  It  is  our  privilege,  however,  to  consider 
"ways  and  means"  for  the  accomplishment  of  this  end  in  a  severely 
practical  light.  The  problem  then  is  :  how  shall  this  recognized  obli- 
gation be  discharged  with  the  least  expense  to  ourselves? 


This  depends,  of  course,  upon  the  kind  of  .provision  for  the  de- 
pendent insane  demanded  by  our  sense  of  duty  enlightened  by  sym- 
pathy as  well  as  intelligence.  What  shall  it  be?  Not  such  as  was 
extended  to  the  insane  of  all  Christian  lands  from  the  accession  of 
Roman  ecclesiasticism  in  Europe  to  the  close  of  the  eighteenth  century  ! 
O  no!  Not  even  such  as  was  considered  satisfactory  in  the  earlier 
decades  of  the  present  century !  Not  by  a  long  way  !  Public  senti- 
ment now  demands  for  the  dependent  insane  not  only  custody  and 
treatment,  but  provision  for  all  the  privileges  and  comforts  of  life  that 
they  are  capable  of  enjoying.  And  this  is  right.  Nothing  could  be 
more  just  or  humane;  nothing  easier  of  accomplishment:  provided 
the  accomplishment  be  referred  to  agents  sufficiently  instructed  and 
informed  of  the  various  degrees  and  peculiarities  of  capability  for 
enjoyment  of  the  different  classes  of  the  insane,  instead  of  to  the 
conceited  zeal  of  public  ignorance,  however  well  intended.  Public 
ignorance  and  mis-information  respecting  insanity  and  the  insane, 
have  given  rise  to  nearly,  if  not  quite,  all  of  the  fadulent  notions  that 
have  made  themselves  known  by  endless  clamor  respecting  public 
provision  for  the  insane  of  late  years — wearisome  enough  to  well-in- 
formed listeners,  if  not  altogether  unprofitable. 

It  has  not  been  the  purpose  of  the  writer  in  preparing  this  paper 
to  renew  or  continue  the  discussion  of  definite  "propositions"  for  the 
proper  care  of  the  insane,  including  location,  buildings,  organization 
and  management,  etc.,  of  public  hospitals  or  asylums,  further  than 
to  submit  a  brief  resume  of  conclusions  reached,  or  opinions  enter- 
tained, after  the  experiences  of  twenty-five  years  service  as  superin- 
tendent of  large  and  small,  public  and  private,  hospitals  for  the  insane, 
and  interested  studies  of  the  characteristics,  capabilities,  and  needs 
of  various  classes  of  dependent  persons. 

These  conditions  have  been  summarized  as  follows: 

(i.)  Intelligent  provision  for  the  insane  implies  provision  for 
various  classes,  according  to  their  capabilities  of  enjoyment,  and  the 
exercise,  under  intelligent  supervision,  of  variously  impaired  faculties. 

(2.)  Public  provision  for  whatever  class  of  insane  persons 
implies :  housing,  clothing,  feeding,  sanitary  and  moral  discipline, 
amusement  and  employment  for  such  as  are  capable  of  being  amused 
or  employed,  and  medical  treatment  for  the  sick:  the  essential  features 
of  such  provision  being,  so  far  as  may  be  practicable  under  given  cir- 
cumstances, adaptability  to  the  needs  of  each  distinctive  class. 

(3. )  Great, expensive, architecturally-imposing  palaces,  providing 
alike  for  all  classes,  however  serviceable  they  may  have  been,  aestheti- 


cally  considered,  in  times  past — as  they  unquestionably  were — are  no 
longer  necessary  nor  appropriate  for  the  ends  indicated.  Yet,  so  the 
insane  are  comfortably  housed,  each  class  according  to  its  condition, 
it  is  comparatively  unimportant  whether  they  be  so  in  large  or  small 
houses;  cottages  or  palaces;  connected  or  detached;  high  or  low 
buildings. 

(4.)  It  is  important  that  the  insane  of  all  classes  be  well  fed 
under  careful  supervision ;  but  whether  in  large  or  small  dining  rooms, 
by  groups,  or  aggregations,  is  of  so  little  consequence  that  it  should 
be  considered  a  matter  of  convenience  rather  than  of  principle. 

(5.)  It  is  important  that  public  institutions  for  the  insane  -be 
well  organized  and  administered ;  but  whether  by  three  or  thirty  trus- 
tees is  a  matter  of  but  little  moment.  Partisan  or  bi-partisan  boards 
of  directors  may  be  equally  good  or  bad.  The  fewer  statutory 
details  for  the  government  of  such  institutions  the  better.  Good 
men  will  govern  a  hospital  well  under  adverse  statutes,  and  bad  men 
will  manage  to  evade  the  wisest  legislation.  The  usefulness  and  rep- 
utation of  a  hospital  for  the  insane  will  reflect  the  characteristics  of 
those  who  direct  or  administer  its'  affairs,  rather  than  the  laws  by 
which  they  are  authorized  to  act,  or  the  political  party  to  which  they 
belong. 

(6.)  It  is  wise  to  retain  in  orifice  capable  men,  who  have  demon- 
strated their  fitness  by  successful  management  of  affairs,  so  long  as 
their  capability  continues  to  be  elastic  ;  but  the  displacement  of  offi- 
cials whose  ideas  have  become  insoluble  by  competent  and  still  grow- 
ing men,  with  or  without  special  training,  should  not  be  regarded  with 
alarm  nor  as  of  doubtful  propriety.  Capability  without  experience  is 
more  valuable  than  experience  without  capability  in  any  executive  po- 
sition. Whatever  ills  attend  "rotation  in  office"  in  this  country,  a 
custom  essential  to  the  vigor  if  not  the  existence  of  partisan  organi- 
zation, without  which  republican  government  would  degenerate — are 
among  the  evils  compensated  by  the  good  of  almost  unlimited  free- 
dom. The  trend  of  human  progress  is  not  seriously  deflected  thereby. 

ARE    THE    INSANE    CURABLE? 

That  insane  persons,  in  some  instances,  recover  normal  capabili- 
ties after  impairment  and  disorder,  is  not  a  question,  but  a  fact. 
Whether  or  not  such  persons  are  greatly,  or  to  any  extent,  aided  to 
recover  by  what  is  done  for  them  by  public  provisions  for  their  treat- 
ment, is  a  question.  How  shall  it  be  answered?  There  is  no  exist- 
ing source  of.  accurate  information  on  the  subject.  Whatever  answer 


5 

is  made  must,  therefore,  be  inferential  and  a  matter  of  opinion  only. 
There  is  a  prevalent  notion,  whether  well  or  ill  founded,  that  the 
chance  of  recovery  for  an  insane  person  is  much  enhanced  by  com- 
mitment to  a  hospital  for  treatment.  A  notion  that  emanated,  proba- 
bly, from  general  practitioners  of  medicine,  who,  as  a  class,  are  only 
too  willing  to  escape  the  responsibility  and  annoyance  of  treating  in- 
sane persons  under  ordinary  circumstances;  and  has  been  confirmed 
by  the  claims  of  distinguished  specialists  administering  the  affairs  of 
stately  institutions,  by  which  their  occupation  and  pretensions  have 
been  greatly  dignified. 

As  an  economical  problem  it  would  be  well  to  know  more  about 
this  matter  than  is  now  known.  If  any  considerable  number  of  in- 
sane persons  are  curable  or  will  recover  under  hospital  treatment,  that 
would  not  recover  otherwise,  then  it  is  a  matter  of  economy  on  the 
part  of  the  state  to  provide  for  such  treatment,  at  an  expense  to  be 
measured  only  by  results.  If  the  average  life  of  a  dependently  im- 
paired insane  person  is  twelve  years,  and  the  average  duration  of  dis- 
ease of  such  as  recover  is  one  year,  then  the  state  can  afford  an 
extraordinary  expenditure  for  the  cure  of  the  curable,  as  each  recovery 
represents  a  saving  of  eleven  years  of  maintenance  of  an  unrecovered 
person.  It  is  not  necessary  to  make  more  definite  calculations;  what 
we  need  to  know  is  that  the  insane  are  amenable  to  treatment.  That 
a  large  proportional  number  of  insane  persons  are  not  curable,  or  re- 
coverable under  any  known  circumstances,  can  not  now  be  denied 
in  the  face  of  facts  the  significance  of  which  admits  of  but  little  ques- 
tion or  modification.  Men  of  experience  and  capability  in  the  specialty 
to-day  smile  interrogatively  or  with  incredulity  at  the  pretensions  of  cure 
made  by  their  not  very  remote  predecessors  in  charge  of  hospitals  for 
the  insane.  Statistics  of  hospitals,  inconclusive  as  they  necessarily 
are  on  most  subjects  requiring  accurate  and  comprehensive  informa- 
tion, are  particularly  so  in  relation  to  the  question  under  considera- 
tion. Hospital  authorities  in  bad  repute  because  of  their  defects  of 
construction  and  administration,  sometimes  exhibit  a  larger  percentage 
of  "cures"  than  do  the  most  reputable. 

My  belief,  based  upon  observed  facts  and  rational  inferences,  is 
that  no  insane  person  who  is  not  spontaneously  recoverable  under 
ordinarily  favorable  circumstances  is  curable  by  extrinsic  influences 
of  any  kind.  No  insane  person  whose  mental  impairment  is  se- 
quential to  structural  changes  of  tissues  immediately  implicated  in  the 
performance  of  mental  functions,  if  of  a  pathological  character,  is 
spontaneously  recoverable  under  any  circumstances.  By  recovery  I 


mean  perfect  restoration  of  normal  conditions ;  not  a  partial  restora- 
tion that  may  pass  for  a  "  cure,"  that  is  after  all,  but  repair. 

Cicatricial  tissues  are  always  less  complex,  hence  less  capable, 
than  the  tissues  which  they  replace  in  the  process  of  reparation.  Tis- 
sues by  which  lesions  of  continuity  of  skin  or  muscular  fibers  are  re- 
paired, are  familiar  examples  of  this  law.  It  is  not  probable  that 
brain  tissue  is  exceptional  or  exempt  from  so  uniform  a  physiological 
process. 

Recoverability  from  insane  conditions  is,  therefore,  limited  to 
persons  whose  mental  impairment  is  attributable  to  lesions  of  other 
than  cerebral  structures,  whereby  the  brain  may  be  temporarily 
deprived  of  its  ordinary  pabulum  or  supplied  with  vitiated  nutriment, 
without  impairment  of  its  structural  integrity;  and  "curability,"  is 
limited  to  such  persons  of  this  class  as  require  the  aid  of  more  favor- 
able circumstances  than  their  ordinary  environments  supply  or  their 
means  may  command,  to  enable  them  to  resist  or  overcome  these 
conditions. 

The  problem  of  public  interest  in  this  connection  then  is : — has 
public  provision  for  the  insane  furnished — can  it  be  made  to  supply — 
essentially  more  favorable  conditions  for  the  recovery  of  the  recover- 
able, than,  as  a  rule,  they  otherwise  enjoy?  • 

That  this  question  should  be  answered  affirmatively  I  have  no 
doubt. 

Concentrated  efforts,  therefore,  should  be  made,  backed  by 
liberal  expenditures  intelligently  directed  toward  the  creation  of 
environments  in  every  way  conducive  to  the  recovery  of  the  recover- 
able ;  while  provision  for  all  other  classes  should  be  made  with  refer- 
ence to  their  individual  welfare  and  the  utilization  of  such  remnants 
of  capability  as  they  may  be  still  possessed  of,  at  the  least,  reasonable, 
expense.  • 

It  may  be  inferred  from  the  foregoing  that  the  writer  does  not 
estimate  medicine  as  the  most  important  factor  in  the  problem  of 
curative  conditions  for  the  insane.  If  by  medicine  is  meant  the 
administration  of  drugs  or  chemicals,  the  inference  is  a  fair  one.  The 
insane  can  be  medicated  elsewhere  as  well  as  they  can  be  in  hospitals 
or  asylums. 

Hospital  physicians  have  no  mysterious  knowledge  of  medicine 
— no  specific — no  secret  remedies. 

Hospitals  for  the  insane  under  the  exclusive  control  of  Doctors 
of  Homeopathy,  claim  larger  percentages  of  cure  than  do  similar  in- 
stitutions administered  by  Doctors  of  Medicine. 


The  administration  of  medicine  or  the  appearance  of  medicine, 
may  still  be  wise,  being  responsive  to  the  necessities  of  the  multitudes 
who  have  not  yet  fully  emerged  from  the  shadows  of  primitive  super- 
stitions, nor  so  far  departed  from  ancestral  types  as  to  be  uninfluenced 
by  the  fetisch  feeling  that  is  common  to  the  race,  forever  suggesting 
supernatural  beings,  designs,  powers,  activities  and  virtues  in  associa- 
tion with  natural  objects  in  explication  of  natural  phenomena.  There 
are  material  medicines,  also,  that  are  neither  poisonous  nor  inert,  that 
in  the  hands  of  skillful  physicians  contribute,  unquestionably,  to  con- 
ditions essential  to  recovery,  as  above  indicated — medicines  that  can 
not  well  be  omitted  in  the  treatment  of  the  insane  under  the  most 
favorable  circumstances.  But  these  are  not,  or  need  not  be,  many — 
nor  should  too  much  dependence  be  placed  upon  their  efficacy  to  the 
neglect  of  other  and  more  important  measures. 

There  are  other  uses,  also,  to  which  medicines  are  now  being 
liberally  appropriated  in  the  treatment  of  the  insane,  that  if  not  cura- 
tive of  those  to  whom  the  medicines  are  administered,  are  comforting 
to  others  with  whom  they  may  be  necessarily  associated — securing  for 
the  time-being  silence  and  languor  instead  of  raving  and  violence ; 
and  at  the  same  time  enabling  the  management  to  assure  an  admiring 
public  of  the  fact  that  all  restraints  have  been  abolished  from  the  hos- 
pital under  their  control,  and  the  greatest  reformation  of  the  age  has 
been  accomplished  by  their  benevolence  and  sagacity ! 

There  may  be  wisdom  in  such  an  appropriation  of  means  ;  knock- 
ing the  insane  down  with  chemical  clubs  and  paralyzing  them  with 
poisons  instead  of  limiting  their  movements  by  camisoles  or  protection 
beds; — but  if  so,  it  is  wisdom  of  a  kind  unknown  to  my  philosophy. 
There  may  be  virtue  in  the  practice — but  if  so,  it  must  be  of  that  kind 
that  is  said  to  be  its  own  reward ! 

If  the  conditions  favorable  to  the  recovery  of  the  recoverable 
insane  do  not  consist  of  special  medication  or  mysterious  methods  of 
treatment  peculiar  to  hospitals  for  the  insane — of  what  then  do  they 
consist  ? 

They  consist,  in  the  first  place,  of  the  authority  vested  in  or  as- 
sumed by  such  institutions  to  control  the  conduct  and  prescribe  the 
modes  of  living  of  the  insane  committed  to  them  for  custody  and 
treatment.  Secondly — notwithstanding  the  fad  of  the  foolish  that 
hospitals  for  the  insane  should  be  made  as  "home-like"  as  possible — 
they  consist  of  better  sanitary  surroundings,  appurtenances  and  ob- 
servances— in  but  few  respects  "  home-like  "  to  the  greater  number  of 
dependent  insane  persons  to  be  benefited  thereby. 


8 

Third — not  greater  skill  in  medicine,  but  more  knowledge  of  the 
insane  on  the  part  of  doctors  and  nurses  than  is  common  to  the  pro- 
fession— hence  more  rational  treatment. 

This  is  all !  But  indeed  this  is  much  when  considered  in  contrast 
with  the  ordinary  home  surroundings,  modes  of  living  and  methods 
of  dealing  with  the  insane,  characteristic  of  the  population  from 
which  the  insane  are,  for  the  most  part,  derivable. 

These  conditions  well  provided  for,  all  the  rest— minor  matters 
about  which  so  much  babble  has  been  heard,  of  mere  "  annise  and 
cummin  "  importance  in  hospital  affairs — however  interesting  to  per- 
sons incapable  of  appreciating  weightier  matters  may  safely  be  per- 
mitted to  take  care  of  themselves. 

IS    INSANITY    PREVENTABLE? 

Theoretically — yes!  Practically — no!  Theoretically,  insanity  is 
preventable — because  so  many  of  the  so-called  "exciting  causes"  of 
insanity,  in  an  ideal  state  of  society  would  either  not  obtain  or  would 
be  prevented.  Practically,  insanity  is  not  preventable — because, 
human  nature  being  as  it  is,  an  ideal  state  of  society  can  not  be  ef- 
fected by  any  means  at  our  command ;  nor  otherwise  than  by  the  slow, 
however  continuous,  process  of  growth. 

There  are  persons  it  is  true,  many  and  worthy  in  their  way,  who 
think  otherwise  and  devote  their  energies  persistently  to  the  accom- 
plishment of  such  ends.  Persons  who  seem  to  be  exceedingly  sensi- 
tive to  special  objects  but  oblivious  to  the  great  fact  of  a  Universe. 
Persons  who  interest  themselves  deeply  in  special  subjects  but  fail  to 
recognize  the  more  important  relations  of  parts  to  aggregates,  or  of 
generals  to  particulars,  without  which  knowledge  is  of  but  little  value. 
Persons  who  think,  if  at  all,  of  the  Universe  as  of  a  limited  domain, 
governed  by  personal  decrees  of  limited  applicability,  and  special 
providences  to  meet  contingent  emergencies  as  they  arise.  Persons 
who  think  of  mankind  as  degenerate  beings  fallen  from  a  high  estate, 
moving  upon  a  down-grade  toward  inevitable  disaster — helpless  of 
themselves,  but  for  an  arrest  of  whose  downward  progress  they  seem 
to  think  it  only  necessary  to  secure  the  enactment  of  some  kind  of  a 
law,  prohibitory  or  other,  whereby  the  race  may  be  restored  to  primi- 
tive conditions  of  innocence  and  happiness.  These  persons  have 
their  uses  and  play  their  parts  in  the  great  drama  of  human  progress 
— failing  of  accomplishment,  however,  because  the  movements  of 
mankind  along  the  lines  of  civilization  are  not  determined  nor  de- 
terminable  by  human  prudence,  wisdom  or  design,  nor  to  be  arrested 


or  greatly  modified  by  whatever  protest,  persuasion  or  statutory  en- 
actment, not  in  harmony  therewith. 

To  prevent  insanity,  the  fact  is  conspicuous  that  the  antecedent 
conditions  essential  to  its  development  must  be  so  modified  as  to 
change  the  sequence. 

What  are  the  antecedent  conditions  essential  to  the  manifestation 
of  insanity  ? 

(a.)  An  inherent,  consequently  inheritable,  peculiarity  of  or- 
ganization, not  common  to  the  race  but  characteristic  of  a  defective 
class  of  persons,  and  recognized  properly,  as  a  structural  "poten- 
tiality of  insanity." 

(b.)  Certain  lesions  of  nutrition — whether  from  deprivation  or 
excess — inanition,  indigestion,  intoxication,  or  inherited  dyscrasias  of 
various  kinds. 

(c.}  Exhaustion  of  organic  energy  transmutable  by  cerebral 
activities  into  mental  force,  by  unusual  or  excessive  expenditure  in 
work  or  dissipation. 

(d.)  Physiological  limitations  determined  by  germinal  or  sper- 
matic conditions,  by  which  structural  types,  growths,  activities  and 
longevities,  of  individuals  are  dominated  through  every  stage  of  exist- 
ence, however  influenced  by  external  relations. 

Of  these  antecedent  conditions,  some  of  which  are  essential  to 
the  development  of  insanity,  it  will  be  seen  at  a  glance  that  not  one 
of  them  can  be  successfully  eliminated  from  present  conditions  ot 
society,  although  there  may  be  an  ideal  remedy  for  each. 

The  first  mentioned,  for  example — that  of  inherited  defect  ot 
organization — might  be  eliminated  in  time  by  counter-marching  the 
column  of  civilization  and  returning  to  primitive,  or  savage,  con- 
ditions of  society,  in  which  the  defective  drop  out  of  the  procession 
early  in  life  because  of  their  original  incompetency  to  continue  the 
effort  required  for  existence,  if  not  aided  and  abetted  thereto  by 
naturally  instructed  or  instigated  kindred,  leaving  only  the  more  per- 
fect to  survive.  But  this  we  will  not  do;  for  whatever  may  be  said 
or  sung  of  the  wisdom  of  nature  and  the  beauty  of  things  natural,  no 
people  having  once  reached  a  high  plane  of  civilization  by  spontaneous 
effort  has  been  known  to  return  to  barbarism  or  savagery.  Disap- 
pointed and  dissatisfied  individuals  occasionally  seek  the  wilderness 
hoping  to  escape  the  exactions  of  good  society,  morally  and  otherwise, 
but  they  represent  exceptional  characteristics. 

Asexualization   of  the   recognizably  defective  and   constitutionally 
vicious,  criminal,  and  otherwise  offensive  and  unfit  members  of  society 


by  surgical  interference,  now  safely  practicable,  would  do  this  business 
in  time.  But  however  patent  the  fact  may  be  that  we  are  breeding 
criminals  and  lunatics  and  paupers  and  prostitutes  at  a  constantly  in- 
creasing ratio,  as  an  inevitable  sequence  of  our  acts  of  benevolence 
and  humanity — and  that  a  compulsory  solution  of  the  problem  will 
some  day  be  made — it  will  require  more  than  one  "  campaign  of  edu- 
cation "  to  secure  the  adoption  of  so  effectual,  rational  and  beneficent 
a  measure.  Meantime  it  is  a  waste  of  energy  to  talk  about  prohibit- 
ing the  legalization  of  marriages  between  defective  parties  as  a  remedy, 
as  all  obstructive  marriage  laws  contribute  only  to  an  increase  ot 
bastardy,  feticide  and  kindred  vices.  The  uniform  demands  of  or- 
ganic appetence  will  not  be  satisfied  nor  held  in  abeyance,  effectu- 
ally, or  to  any  considerable  degree,  by  statutory  enactments.  Comets 
have  never  been  deflected  from  their  courses  by  papal  bulls ;  nor  can 
the  imperious  sentiment  of  sex  in  man  be  suppressed  by  ordinances. 

Many  worthy  persons  now  believe  that  the  second  conditions 
mentioned — so  far  at  least  as  they  may  be  incidental  to  alcoholic  in- 
toxication— can  be  corrected  by  law.  But,  however  commendable 
their  motives,  or  valuable  their  work  consistent  with  such  belief,  the 
advocates  of  "  prohibitory  laws  "  for  the  elimination  of  alcoholic  in- 
temperance from  society  must  admit  that  the  end  is  still  far  from  ac- 
complishment with  but  little  probability  of  success  in  the  near  future. 

There  are  other  poisons,  also,  that  are  more  efficient  than  alcohol 
as  ordinarily  used,  in  the  provocation  of  insanity — poisons  that  are 
developed  within  the  body — the  presence  of  which  is  neither  voluntary, 
nor  recognized  as  vicious  in  a  moral  sense  by  unskilled  observers, — 
but  none  the  less  indicative  of  depravity  of  organization,  manifested 
by  depravity  of  functions  to  which  such  poisoning  is  attributable. 
Neither  men  nor  women — not  even  Doctors  of  Medicine — have  ever 
been  persuaded  or  compelled  to  live  rationally  at  the  expense  of 
natural  or  acquired  inclinations  or  appetites,  or  in  violation  of  the 
decrees  of  Fashion. 

Conditions  (c] — or  the  undue  expenditure  of  organic  energy, 
whether  by  overwork  or  the  indulgence  of  exciting  passions,  can  not 
be  interfered  with  to  any  considerable  extent  without  encroaching  upon 
the  "inalienable  rights"  of  persons  to  an  intolerable  degree.  Ambi- 
tious men  and  necessitous  women  will  continue  to  exhaust  their  ener- 
gies by  untimely  toil.  Gamblers  of  all  grades  of  respectability,  will 
strain  their  faculties  to  utmost  tension  in  their  efforts  to  exchange 
nothing  for  something — whether  it  be  to  effect  a  "corner  in  wheat" 
or  beat  a  faro-bank.  The  libidinous  will  not  cease  to  pursue  their 


pleasures,  sacrificing  sleep  at  the  shrine  of  Venus;  and  anxious  wives 
and  mothers  with  saddened  brows  \vill  still  keep  vigils  awaiting. the 
return  of  recreant  husbands  and  undutiful  or  prodigal  sons.  These 
are  things  that  can  not  be  controlled  by  law,  nor  rapidly  modified  by 
education. 

Conditions  (d] — of  unquestionable  force  and  importance — pre- 
ceding, and  probably  involving  all.  subsequent  conditions  incidental 
to  constitutional  evolution,  are  not  sufficiently  within  the  scope  of 
present  knowledge  to  be  corrected  by  any  known  method  of  inter- 
ference. 

Insanity  is,  therefore,  not  only  not  .preventable,  but  increasing 
and  certain  to  increase  with  the  progress  of  civilization,  that  by  its  arts 
and  charities  stays  the  relentless  and  remorseless  hand  of  Nature 
from  weeding  her  garden  of  humanity  of  the  defective,  superfluous, 
and  unprovided  for. 

Is  this  a  gloomy  outlook  for  the  future  of  humanity  ?  Not  for 
him  who  has  come  to  recognize  humanity  as  a  part  and  parcel  of  the 
universe,  harmonious  in  its  co-relations,  responsive  to  its  own  neces- 
sities under  all  of  the  varying  conditions  of  its  historic  development. 
To  such  only  as  in  their  egotistic  infidelity  and  short-sightedness  think 
that  the  conduct  of  the  universe  depends  upon  their  action,  and  ap- 
prehend immediate  disaster  should  their  schemes  fail  of  accomplish- 
ment, is  the  future  ever  beclouded. 

Thus  far  the  strong  have  been  strengthened  by  bearing  the 
burden  of  the  weak.  When  the  burden  shall  have  increased  beyond 
certain  limitations  there  will  be  a  response  to  impending  necessities, 
the  character  of  which  we  need  not  now  anticipate.  Our  duties  are 
immediate,  and  pertain  to  whatever  is  nearest  to  be  done.  What  we 
do  constitutes  the  antecedents  of  sequences  that  we  call  the  future; 
to  differ  widely  from  results  anticipated  or  predicted  by  those  who 
are  the  conspicuous  actors  of  any  given  present  time  or  generation. 


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